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Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: Outcome analysis and prognostic factors.
Surgery. 2017 09; 162(3):500-514.S

Abstract

BACKGROUND

Extensive resection for hilar cholangiocarcinoma is the most effective treatment, but high morbidity and poor prognosis remain concerns. Previous data have shown marked differences in outcomes between comparable Eastern and Western centers. We compared the outcomes of the management for hilar cholangiocarcinoma at one Japanese and one British institution with comparable experience.

METHODS

Of 298 consecutive patients with hilar cholangiocarcinoma evaluated at Hirosaki University Hospital, Japan and St. James's University Hospital, Leeds, UK, 183 underwent radical resection. Clinicopathologic variables and postoperative outcomes were compared.

RESULTS

Significant differences were not observed between the Hirosaki and Leeds cohorts in overall outcomes despite several differences in the patient characteristics. Although there was a difference in 90-day mortality (2.5% vs 13.6%, respectively), disease-specific 5-year survival rates were 32.8% and 31.9%, respectively (P = .767). Multivariate analysis identified trisectionectomy (odds ratio = 2.32; P = .010), combined pancreatoduodenectomy (odds ratio = 7.88; P = .010), and perioperative blood transfusion (odds ratio = 1.88; P = .045) were associated with postoperative major complications, while preoperative biliary drainage associated with postoperative major complications, while preoperative biliary drainage (risk ratio = 2.21; P = .018), perioperative blood transfusion (risk ratio = 1.58; P = .029), lymph node metastasis (risk ratio = 2.00; P = .002), moderate/poorly differentiated tumor (risk ratio = 1.72; P = .029), microvascular invasion (risk ratio = 1.63; P = .046), and R1 resection (risk ratio = 1.90; P = .005) were risk factors for poor survival.

CONCLUSION

Disease-specific survival and prognostic factors were similar in both centers. Meticulous operative technique to avoid perioperative blood transfusion may improve long-term survival.

Authors+Show Affiliations

Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of HPB and Transplant Surgery, St. James's University Hospital NHS Trust, Leeds, UK.Department of HPB and Transplant Surgery, St. James's University Hospital NHS Trust, Leeds, UK.Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.Department of Pathology, St. James's University Hospital NHS Trust, Leeds, UK.Department of HPB and Transplant Surgery, St. James's University Hospital NHS Trust, Leeds, UK.Department of HPB and Transplant Surgery, St. James's University Hospital NHS Trust, Leeds, UK.Department of HPB and Transplant Surgery, St. James's University Hospital NHS Trust, Leeds, UK.Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.Department of HPB and Transplant Surgery, St. James's University Hospital NHS Trust, Leeds, UK. Electronic address: peter.lodge@nhs.net.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

28551378

Citation

Kimura, Norihisa, et al. "Radical Operation for Hilar Cholangiocarcinoma in Comparable Eastern and Western Centers: Outcome Analysis and Prognostic Factors." Surgery, vol. 162, no. 3, 2017, pp. 500-514.
Kimura N, Young AL, Toyoki Y, et al. Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: Outcome analysis and prognostic factors. Surgery. 2017;162(3):500-514.
Kimura, N., Young, A. L., Toyoki, Y., Wyatt, J. I., Toogood, G. J., Hidalgo, E., Prasad, K. R., Kudo, D., Ishido, K., Hakamada, K., & Lodge, J. P. A. (2017). Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: Outcome analysis and prognostic factors. Surgery, 162(3), 500-514. https://doi.org/10.1016/j.surg.2017.03.017
Kimura N, et al. Radical Operation for Hilar Cholangiocarcinoma in Comparable Eastern and Western Centers: Outcome Analysis and Prognostic Factors. Surgery. 2017;162(3):500-514. PubMed PMID: 28551378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radical operation for hilar cholangiocarcinoma in comparable Eastern and Western centers: Outcome analysis and prognostic factors. AU - Kimura,Norihisa, AU - Young,Alastair L, AU - Toyoki,Yoshikazu, AU - Wyatt,Judith I, AU - Toogood,Giles J, AU - Hidalgo,Ernest, AU - Prasad,K Rajendra, AU - Kudo,Daisuke, AU - Ishido,Keinosuke, AU - Hakamada,Kenichi, AU - Lodge,J Peter A, Y1 - 2017/05/24/ PY - 2017/01/12/received PY - 2017/03/09/revised PY - 2017/03/20/accepted PY - 2017/5/30/pubmed PY - 2017/9/14/medline PY - 2017/5/29/entrez SP - 500 EP - 514 JF - Surgery JO - Surgery VL - 162 IS - 3 N2 - BACKGROUND: Extensive resection for hilar cholangiocarcinoma is the most effective treatment, but high morbidity and poor prognosis remain concerns. Previous data have shown marked differences in outcomes between comparable Eastern and Western centers. We compared the outcomes of the management for hilar cholangiocarcinoma at one Japanese and one British institution with comparable experience. METHODS: Of 298 consecutive patients with hilar cholangiocarcinoma evaluated at Hirosaki University Hospital, Japan and St. James's University Hospital, Leeds, UK, 183 underwent radical resection. Clinicopathologic variables and postoperative outcomes were compared. RESULTS: Significant differences were not observed between the Hirosaki and Leeds cohorts in overall outcomes despite several differences in the patient characteristics. Although there was a difference in 90-day mortality (2.5% vs 13.6%, respectively), disease-specific 5-year survival rates were 32.8% and 31.9%, respectively (P = .767). Multivariate analysis identified trisectionectomy (odds ratio = 2.32; P = .010), combined pancreatoduodenectomy (odds ratio = 7.88; P = .010), and perioperative blood transfusion (odds ratio = 1.88; P = .045) were associated with postoperative major complications, while preoperative biliary drainage associated with postoperative major complications, while preoperative biliary drainage (risk ratio = 2.21; P = .018), perioperative blood transfusion (risk ratio = 1.58; P = .029), lymph node metastasis (risk ratio = 2.00; P = .002), moderate/poorly differentiated tumor (risk ratio = 1.72; P = .029), microvascular invasion (risk ratio = 1.63; P = .046), and R1 resection (risk ratio = 1.90; P = .005) were risk factors for poor survival. CONCLUSION: Disease-specific survival and prognostic factors were similar in both centers. Meticulous operative technique to avoid perioperative blood transfusion may improve long-term survival. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/28551378/Radical_operation_for_hilar_cholangiocarcinoma_in_comparable_Eastern_and_Western_centers:_Outcome_analysis_and_prognostic_factors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(17)30233-7 DB - PRIME DP - Unbound Medicine ER -